Urethral trauma


Female (a) and male (b) urethra.
The human male urethra laid open on its anterior (upper) surface.
Transverse section of the penis.
  • Commonly result of blunt trauma
  • Missed or inadequately managed injuries can result in strictures and recurrent urologic procedures


  • Anterior
    • Located anterior to the membranous urethra
    • Straddle injuries, self-instrumentation
  • Posterior
    • Located in the membranous and prostatic urethra
    • Due to blunt trauma from massive deceleration[1]
    • Often accompanies pelvic fracture

Clinical Features

  • Hematuria, dysuria, inability to void, blood at meatus
  • Vaginal bleeding
  • Perineal or scrotal hematoma
  • High-riding or detached prostate
    • Associated with complete posterior urethral disruption
    • "ATLS ® -10 has now removed rectal examination for this purpose due to the poor sensitivity (2%) demonstrated for this maneuver." [2]

Differential Diagnosis

Genitourinary Trauma


  • Standard "trauma CT" is likely to miss urethral trauma[3]
  • Retrograde urethrogram
    • Must perform before catheterization to prevent further urethral injury; inflate balloon with 2-3ml of saline to minimize displacement
    • 20-60 mL of water soluble contrast in toomey syringe
      • Can mix contrast with lubricating jelly in 1:1 ratio to minimize leakage.[4]
    • Stretch penis perpendicularly across patient's thigh to unfold urethra.
    • Inject 20-60 cc slowly into urethra (to prevent venous intravasation) while putting pressure on the glans to prevent leakage, shoot KUB during last 10 mL
    • No bladder filling with extravasation - complete tear
    • Bladder filling with extravasation - partial tear


  • Posterior urethral injury
    • Suprapubic cathether placement
    • Surgery is usually performed weeks later
  • Anterior urethral injury
    • Penetrating injuries require surgical exploration and repair


See Also


  1. Andrich DE, Day AC, Mundy AR. Proposed mechanisms of lower urinary tract injury in fractures of the pelvic ring. BJU Int. Sept. 2007;100:567-73
  2. Advanced Trauma Life Support® Update 2019: Management and Applications for Adults and Special Populations.
  3. Lawson CM, Daley BJ, Ormsby CD, Enderson B. Missed injuries in the era of the trauma scan. J Trauma. Feb, 2011;70:452-6.
  4. https://www.emrap.org/episode/trauma-em-fundamentals/urogenital 12:40